| NPI | 1295762623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 28516) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35052372) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-04-12 |